225159 10/09/2013 CITY OF CARMEL, INDIANA VENDOR: 367268 Page 1 of 1
ONE CIVIC SQUARE ADAMS INDUSTRIES INC CHECK AMOUNT: $590.00
CARMEL, INDIANA 46032 PO BOX 641413
o� LOS ANGELES CA 90064 CHECK NUMBER: 225159
CHECK DATE: 10/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4239010 202211 521 . 27 AMMUNITIONS & ACCESSO
1110 R4239010 25554 202211 68 . 73 MOUNT SYSTEM/ASSEMBLY
Invoice
kE
P.O. Box 641413
Los Angeles, CA 90064 DATE INVOICE#
(310) 47
2-3017 (310) 861-5324 Fax
,Z° EIN/TIN: 95-4547850; CAGE: 1 SMP2
U S1
9/30/2013 202211
BILL TO SHIP TO
CARMEL POLICE DEPARTMENT CARMEL POLICE DEPARTMENT
ATTN:TERESA ANDERSON 3 CIVIC SQUARE
3 CIVIC SQUARE CARMEL,IN 46032
CARMEL,IN 46032 USA
Email:rjellison a carmel.in.gov
P.O. NUMBER TERMS DUE DATE REP SHIP VIA F.O.B.
35353 Net 30 10/30/2013 CBA 9/30/2013 UPS DELIVERED
QUANTITY ITEM CODE DESCRIPTION PRICE EACH AMOUNT
2 1863010 1863010:NOROTOS DOVETAIL HELMET MOUNTS FOR 295.00 590.00T
ACH HELMET.
Subtotal $590.00
Export of the items described herein may require an export license issued by the U.S.
Department of Commerce,Bureau of Industry and Security,or the U.S. Department of Sales Tax (0.0%) $0.00
State,Office of Defense Trade Controls. It is the responsibility of the purchaser to comply
with all appropriate U.S.Laws.
Total $590.00
Past Due Accounts that go over their terms will be charged a 1.5%finance charge per
month they are overdue.
Payments/Credits $0.00
Please make your check payable to Adams Industries,Inc.and mail it to P.O. Box 641413; p
Los Angeles,CA 90064. Balance Due
$590.00
Wiring Information: City National Bank;2029 Century Park East Suite 100;Los Angeles,
CA 90067;+1-310-282-7808 phone;ABA/Routing Number: 122016066 SWIFT Code
(International): CINAUS6L;Account name:Adams Industries,Inc.;Account Number:
001-301-519.
INDIANA RETAIL TAX EXEMPT PAGE
City ®f C�a el CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35-60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
12M3012
Tactical Night Vlsl'an Camp y Camel Police Department
VENDOR SHIP 3 Civic Square
25612 Barton Road*M TO � I3 IN
Loma Linda„ CA 92354-3110
0
CONFIRMATION BLANKET CONTRACT - PAYMENTTERMS 1� FREIGHT• ' a
QUANTITY UNIT OF MEASURE DESCRIPTION V UNIT PRICE EXTENSION
Account 42 A0
3 Each PEC-15 $1,626.99, $4,8$0.$7/
3 Each WicoX L4 623 Mount SWem $1,352.51 $4,058.73
3 Each Norctcs MICH NVG ICJ ount Assembly �. $215.00 $U5.0 w/
Sub Total- $9,594-70
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Send Invoice To: - y
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Carmel Police Dtpaitment
Aft n. Tevesa Anderson
3 Civic squaw
Carmel, IN PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
CeIr tei Police Duff, r ��� PAYMENT .70
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
i7 f NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
• I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIPPING INSTRUCTIONS THIS APPROP,RIAVION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•SHIP REPAID.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BYdi
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. '� hIc of Police
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. -
J 5'-'4 CLERK-TREASURER
DOCUMENT CONTROL NO. A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO.._._._----------WARRANT NO._--_-..__-__
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except_
20
-_................_........._.....................................__........._.................. ...................._.......__....... ........._.....
Signature )
.................._._..........--................--.............-....
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
ALLOWED 20
Adams Industries, Inc.
IN SUM OF $
P.O. Box 641413
Los Angeles, CA 90064
$521.27
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
6� �
PO#/Dept. INVOICE NO. I ACCT#!TITLE AMOUNT Board Members
I hereby certify that the attached invoice(s), or
202211 I 42-390.10 I $521.27
-7 Z bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
(� received except
Monday, September 30, 2013
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No.201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
09/30/13 202211 night vision equipment $521.27
I hereby certify that the attached invoice(s), or bill(s), is (are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer